The community health center movement in the United States may have had its beginning at Columbia Point, Dorchester, in 1965, but only after the idea had been conceived and executed more than 8,000 miles away.
In the late 1950s, H. Jack Geiger, a Brooklyn native who was attending medical school at Case Western Reserve in Cleveland, earned a Rockefeller Foundation scholarship, which allowed him to travel to South Africa where he encountered Sidney and Emily Kark, British doctors who had created the community health center model and called it Community Oriented Primary Care (COPC).
After returning to the US, and finishing medical school in 1958, Geiger moved to Boston and did his residency in internal medicine at Boston City Hospital over the next six years. Geiger also worked on other keen interests during that time, especially the civil rights movement. In 1964, he helped found the Medical Committee for Human Rights (MCHR), which he described as the medical arm of the civil rights initiatives.
Geiger’s involvement with the civil rights movement was a longstanding one. In 1940, when he was 14 years old, his parents took him to Harlem to see the play “Native Son” and there he encountered Canada Lee, a famous African-American actor and Broadway star. Later, Geiger went to see Lee at his home, where he was invited to stay. During his time with the actor, he met with and followed the doings of numerous civil rights activists, which honed his interest in the overall movement.
In the years between 1958 and 1964, Geiger was a busy man and doctor. He took time off duty as a junior faculty member at the Harvard School of Public Health to serve in Mississippi as a field coordinator for the MCHR. There, during the Freedom Summer of 1964, he met Dr. Count Gibson, a Georgia native who was chair of the Preventive Medicine department at Tufts Medical School.
In January 1965, Geiger went to Washington, D.C. to meet with Sanford Kravitz, one of the leaders of the Office of Economic Opportunity, which had been created by President Lyndon B. Johnson as part of the War on Poverty. Geiger stressed the valuable role community health centers could play in the US and asked Kravitz for $30,000 for a feasibility study.
“You can’t have that,” Geiger recalled Kravitz telling him. “You have to take $300,000 and do it now.”
In short order, with Tufts University as a sponsor, the Boston Housing Authority agreed to renovate four apartments in the Columbia Point Housing Project as a base and on Dec. 11, 1965, the Columbia Point Health Center became the first such clinic in the nation to open its doors, focusing . Delta Health Center, the rural model under the Tufts aegis, then opened in Mound Bayou, Mississippi, after overcoming numerous political obstacles.
It was the start of something great.
Dan Driscoll, the president and CEO of Harbor Health Services, the agency that was formed as a result of a1985 merger between Columbia Point Health Center and Neponset Health Center, said the model created by Geiger and Gibson was a breakthrough social innovation. “It was designed to bring comprehensive health care to underserved communities, to the people who needed it the most but had been left behind,” he said.
Murielle Rue can attest to the effect of that breakthrough. She moved to Columbia Point in 1956 – the “first African-American in my building” – and brought up her family there while working at Geiger Gibson for 34 years, first as a receptionist then as head of medical records. She still lives on Columbia Point, in the Harbor Point development that was created in the early 1990s.
“The health center was a godsend,” Rue said. “Before it came, any time we had to go to the hospital if it was an emergency we had to call the police. We couldn’t afford cabs and there were no buses. It was a blessing when they built the health center.”
Public transportation eventually made its way to Columbia Point, but it could take up to six hours round trip to visit one of the downtown hospitals located only a few miles away. It could be a taxing ordeal, especially for a mother with children, or elderly residents.
Not long after its opening, as many as 200 patients per day were being seen at Columbia Point, but the ultimate testament to the success of the model created by Geiger and Gibson was what came next: Within five years, 18 more health centers opened in Boston.
Today, 50 years after it all began, community health centers in the US serve 23 million people at more than 9,000 sites. Something great, indeed.
In the late 1970s, life was tough on Columbia Point. Crime and illegal drug use were rampant, and when the economy faltered, there was decreased investment in the facilities by the government. Buildings were boarded up while some 400 families remained in residence there. The residents were among the poorest in the city and had some of the greatest medical needs.
Addressing those needs was not always easy. “If you called an ambulance, they would come to the entrance to the peninsula and wait for the police to escort them in,” said Bob Taube, the first executive director of the health center after the 1985 merger with Neponset Health.
As conditions deteriorated, many more people left, although it might more accurately be portrayed as an escape. Fewer people living at Columbia Point meant fewer patients for the health center, which was placed into receivership with Action for Boston Community Development (ABCD) as the grantee. Scovell & Associates, a consulting firm that specialized in managing health centers, was brought in to assume leadership of the day-to-day operation.
Mel Scovell, a former head of Medicaid services for the Commonwealth, served as executive director, with Chuck Schwager his right-hand man. They reported to the board of directors.
One of Scovell’s first hires was Dr. Paul Gustafson, a pediatrician who came on board in 1977 after completing his residency at Boston City Hospital. Gustafson spent most of his first year building a practice, though it got to the point that he thought it may have been for naught.
“I remember a Friday morning in August or September of 1979,” he said, “when we received a notice that the health center was going to close (for good) at 5 p.m. that day,” he recalled.
By noon, a meeting with representatives from the Boston Department of Health and Hospitals was convened and Health and Hospitals agreed to become the grantee for the health center, replacing ABCD and committing to 18 months in that role, according to Gustafson.
One of the priorities for Health and Hospitals was to name an on-site medical director, a position that eventually went to Gustafson. Schwager became acting executive director several months later and the two worked well together. When Schwager and Scovell completed their assignment, Health and Hospitals essentially left as well, allowing the health center to transition back to being an independent organization.
Gustafson, who still practices pediatrics at Neponset Health Center, called the early 1980s a “rollercoaster ride” for the health center. By 1984, the rollercoaster was dangerously close to going off the track. But help was not far away – about three miles to be exact.
Enter Neponset Health
While the center at Columbia Point was struggling to survive, the Neponset Health Center was thriving. It had opened in 1970 as the result of a grassroots movement that saw people, especially young mothers, going door to door to solicit community support.
The case for a health center in the Neponset section of Dorchester included many of the same points that had been made at Columbia Point.
“It took three exchanges on the T to get to Carney Hospital three miles away,” said Jean Hunt, a 45-year nurse and founding member of the Neponset Health Center board of directors. Adder her husband Jim, a former Neponset board president who is president and CEO of the Massachusetts League of Community Health Centers: “The original focus of Neponset Health Center was to provide services to mothers and children.”
The Neponset board was asked to consider merging with the Columbia Point. “In 1985, there could not have been a more unlikely alliance,” said Driscoll, who was the director of Neponset at the time. “Neponset and Columbia Point were serving two starkly different demographics, even though they were only three miles apart.”
The merger was done, and the name Harbor Health Services was chosen to represent both the Neponset and Columbia Point neighborhoods. A few years later, in 1990, the Columbia Point Health Center was renamed the Geiger Gibson Community Health Center and the boards of the two centers were combined into a single Harbor Health board offering a common vision.
Taube, a psychologist who had been serving as director of mental health services at Neponset, took over as executive director at Geiger Gibson after the merger – and after Schwager had returned temporarily to evaluate Columbia Point and ensure it was viable.
A neighbor checks in
The health center on Columbia Point was now part of a new agency and had a new name; all it needed now was a new home.
As a student at nearby BC High, Joe Corcoran had watched the Columbia Point Housing Project being built in the early 1950s. Three decades later, as principal of one of Boston’s leading development companies, he wanted to tear it down and start over.
Although it was a federal project, and Corcoran Jennison was the only bidder, the Boston Housing Authority was in no hurry to have public housing units demolished, even with the promise of new and improved housing stock. “Nobody wanted to touch it,” Corcoran recalled.
When Corcoran revisited the issue with the US Department of Housing and Urban Development, he got the go-ahead and Corcoran Jennison worked with Geiger Gibson and architects on the design. Ground was broken in March 1989, with a brick from the original health center placed in the foundation of the new building, which opened in 1990.
“Columbia Point has been in the forefront of not only providing quality, affordable health care, but is also instrumental in assisting the community to adapt to the challenging demands of ethnic, racial and economic diversity,” noted Ray Flynn, at the time the mayor of Boston. “Columbia Point has been a vital strand in the fabric of Boston social life.”
The new health center was part of a sweeping overhaul of public housing on Columbia Point, which was rebranded as Harbor Point in 1990.
Most of the buildings in the original project were demolished; the others were completely renovated. Columbia Point went from being a highly undesirable neighborhood to a sought-after destination. Today, there are 1,283 units – 400 public housing and 883 market rate.
“This is the safest place in the city to live,” said Murielle Rue, a nearly 60-year resident.
A new health dynamic
With the change in housing stock on Columbia Point came a significant change in demographics. Fewer low-income residents on Columbia Point meant fewer people inclined to take advantage of the services offered by the health center. The key to Harbor Health Services’ long-term survival has been a willingness to adapt to the needs of the community.
Over the last three decades, Harbor Health has grown to be one of the state’s largest and most diversified community health agencies. The agency developed the Elder Service Plan, a program for frail elders at risk of nursing home admission, in 1996. In 2000, it the Ellen Jones Community Dental Center in Harwich. A full-service community health center was opened in Hyannis in 2003. And, in 2014, as part of the national expansion of the community health center program and the passage of the Affordable Care Act, a fifth center was opened in Plymouth. HHS also operates three Women and Infant Children (WIC) programs in Dorchester. The Neponset Health Center collaborates with Steward Carney Hospital on treatment and prevention of infectious diseases such as HIV and Hepatitis C.
Turning 50 is worthy of celebration for any organization, but it is especially gratifying for the Geiger Gibson Community Health Center to reach the milestone, considering the obstacles it has overcome to get there and the role it has played in the history of health care in the life of a Boston neighborhood and across the country.
“Geiger Gibson is part of this community,” said Murielle Rue. “It always will be.” And as it should be, for this is where it all began.